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Endoscopic third ventriculostomy in the treatment of
hydrocephalus in posterior fossa tumors in children
Ruggiero C, Cinalli G, Spennato P, Aliberti F, Cianciulli E, Trischitta
V, Maggi G
Department of Pediatric Neurosurgery, Santobono Children's Hospital, Via
Mario Fiore 6, 80129 Naples, Italy.
Object. The purpose of the present study is to assess the effectiveness of
endoscopic third ventriculostomy (ETV) in children with hydrocephalus
related to posterior fossa tumors.
Methods. Between September 1999 and
December 2002, 63 children with posterior fossa tumors were treated at
Santobono Hospital in Naples, Italy.
Twenty-six patients had severe
hydrocephalus.
In order to relieve intracranial hypertension before tumor
removal, 20 were treated with ETV, and 6 with ventriculo-peritoneal (VP)
shunts.
Twenty patients with mild hydrocephalus were treated with diuretics,
corticosteroid agents, and early posterior fossa surgery, and 17 patients
who did not have hydrocephalus were treated by elective posterior fossa
surgery.
Another 4 ETV were performed in the management of postoperative
hydrocephalus.
Results. Preoperative ETV procedures were technically
successful.
One was complicated by intraventricular bleeding.
The successful
19 preoperative ETV resolved intracranial hypertension before posterior
fossa surgery in all cases.
Three of these 19 patients developed
postoperative hydrocephalus and were treated by VP shunt insertion after
posterior fossa surgery.
Out of the 4 ETV performed after posterior fossa
surgery, only 2 were successful, both when the shunt malfunctioned.
Conclusions. Endoscopic third ventriculostomy should be considered as an
alternative procedure to ventriculo-peritoneal shunting and external
ventricular draining for the emergency control of severe hydrocephalus
caused by posterior fossa tumors, since it can quickly eliminate symptoms,
and hence, can delay surgery scheduling if required.
Even though ETV does
not prevent postoperative hydrocephalus in all cases, it does protect
against acute postoperative hydrocephalus due to cerebellar swelling.
In
addition, it eliminates the risks of cerebrospinal fluid (CSF) infection
related to external drainage and minimizes the risk of overdrainage because
it provides more physiological CSF drainage than the other procedures.
Since
postoperative hydrocephalus is very often physically obstructive, ETV should
always be considered a possible treatment procedure.
PMID: 15221247 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15221247
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